Saturday, April 28, 2012

Thoughts on Being a Compassionate Presence

This week, I had a new nurse shadowing me. Every time a new IDT [interdisciplinary team] member signs on with Iowa Hospice, part of their orientation is to shadow me [and the other disciplines as well]. This is show them the roles of their other team members. As we were driving to see a client, she asked me, "What are your goals if someone cannot respond to you at all? What if you've never heard them talk or seen them respond? Do you still see them?" I responded by saying, "Well, then, if I see them, it is to provide compassionate presence." Then I had the task of trying to define what that looks like and the rationale for that little phrase "compassionate presence."

I like the way this Edge Magazine article defines "compassionate presence":

"Being completely present with one who is suffering means being able to be present with the suffering itself. This, you may recall, is the very definition of compassion. True compassionate presence is not about denying someone his experience with the dark realities he is experiencing; instead, it provides illumination that allows him to explore all the aspects of his situation with clarity."

That sounds very holistic and spiritual, right? This is something I strive to be in my professional and personal life, but what does that look like in a medical setting? What does that look like? How does one become or provide a compassionate presence? I am by no means an expert on the subject, but I would like to take some time and discuss how it plays into the care I provide for my clients.

It's a hard thing to see happening, first off. If someone walks into a session where the goals are to provide compassionate presence, it may just look like I'm playing guitar for someone who is sleeping. The music may sound pretty, but it's hard to see what is being accomplished. I hold the belief, however, that part of showing someone they matter and giving them the dignity that is due all people is spending quality time with them. Essentially saying, in not so many words, "You matter! If you did not matter, I would not be here spending time with you." It is being empathetic, aware of how they may be feeling, even if they cannot tell you, and being a part of their journey for a short time. This may be accomplished simply by breathing with someone or talking with someone about the things that matter, or used to matter, to them. Being completely present with someone, not worried about what else you have to do or where you should be, is a gift that everyone can bring.

In the medical field, even hospice [although not to the same degree], a lot of emphasis is placed on results. Is this medication working? Do we need to adjust their visits? What is the problem and how do we fix it? All this is most definitely valuable, but does not give people much time to just sit and be with someone, not thinking about the laundry list of other tasks to be completed in the day. Simply focusing, instead, on the patient. This makes them more than a patient with a diagnosis and poor prognosis, but transforms them into a person, capable, or once capable, of so many things. This levels the playing field, bringing people to their most basic role - being people who help people.

My challenge for you, then, is to take some time this next week, and really try to be a compassionate presence for someone. Whether that is your spouse, friend, co-worker, parent, or child, give it a try. It may be hard, but, like everything, it takes practice and the dividends are great.

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As you do this, which I hope you do, take some time to read up on another great music therapy blog called Mindful Music Therapist.

Friday, April 20, 2012

Music as a Coping Technique

I had an interesting session on Monday morning with a client. She's fairly young, in her late 60s, and had a rough weekend. One of her medications causes some blood thinning and she got a cut that would not stop bleeding. It had slowed and stopped by Monday, but emotions were still raw for her. She was very anxious and, literally, afraid for her life. Another bleed like that could be her cause of death. When I got there, I saw that she was attempting to convince me [and possibly herself] that she was doing okay. One thing I do feel I excel at, however, is reading people's emotions, and I was picking up that she was not feeling positive about her situation.


We talked for a bit and I began to offer song choice for her, which is one way that I've found to read people's emotions. This client, generally, chooses the song that reflects how she feels. I would offer a "happy" song and once that I felt seemed to reflect what she was feeling. She always chose the reflective song. After a few of these songs, I began to make reflections on the songs and "pry" into her emotions. After she realized what songs she had been choosing what she perceived to be "sad" or "negative", she began crying. I let her cry, without interrupting, and, when she had finished, I said, "It seems like the music is helping you cope with your emotions, but not in the way you thought it was." She agreed and discussed how she used music to "help me when I'm really down", but hadn't realized that by reflecting what she felt, she was coping. 

I think a misconception of using music as a coping technique is that if you play happy music, it will make you happy. Conversely, in this scenario, if you play sad music, it will make you sad. People do not want to be sad, generally, so people may only play happy music. This coping technique, sometimes called avoidance, may be useful for some people, but they do not realize there are other ways. Reflecting the emotions, and owning up to them, can also be an effective way to handle emotions.


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Blog for the week is Music Therapy Source. It's run by a great hospice music therapist out of Iowa City.

Saturday, April 14, 2012

Regional Conference review


Yesterday, I went to the Midwestern American Music Therapy Association regional conference at the University of Iowa. It's a multi-day event, but I only went to it yesterday. My employer offered to pay for one day there and reimbursed one day's worth of registration fees. It was a really great thing for them to do. As this was the first day of concurrent sessions, there was an opening session, with a keynote address outlining the accomplishments of music therapy advocacy over the past year. It was by Dr. Mary Ellen Wylie, who is the president of the American Music Therapy Association. It also featured the Afro-Cuban drum and dance performance group at UI, which was really interesting and fun to see and hear.

There were two times of concurrent sessions, which means that there were multiple presentations going on at one time and you get choose which you attend. It is always a tough decision, however, because there are usually more than one presentation that sounds interesting. Because there are multiple music therapists that work for Iowa Hospice, we sat down and decided we'd each go to one, take notes, and pass them off to each other at a later day. Then, overall, we all get more useful information. My first session, then, was entitled "ENGAGE in Advocacy: Your Role in State Recognition." To make a long story short, music therapy "task forces" in 38 states are trying work with state governments to become a licensed or registered profession according to state law. This would increase music therapy awareness and make it easier for people to become involved in music therapy, either by becoming a music therapist, becoming a client, or letting music therapists [potentially] be reimbursed through Medicare/Medicaid. There have been a few successes, the most recent in Georgia, where a bill passed through their state Senate licensing music therapists. This would increasing the regard for music therapists by the state government. Iowa, where I call home, is planning a Hill Day next year where we can, perhaps, meet a state representative who will sponsor a bill for us. Overall, this was a very informative session and, to be honest, much more interesting that I had anticipated! To take part in advocacy, the presenters encouraged us to ENGAGE, stands for the following:
Educate everyone
Nurture relationships
Grassroots networking
Access for clients
Grasstop connections
Empower people

The second session I attended was called "Therapeutic Music or Entertainment: A View from Health Professionals and our Response." This presentation outlined an in-service provided by two music therapists to hospital and hospice employees. They educated on the differences between music therapy and entertainment and between music therapy and other therapeutic music practices. The three other practices they discussed were music practitioners, music thanatologists, and harp therapists. All these practices have some similarities with music therapists, in that they have training programs, use music, work in medical settings, and are generally misunderstood by the public as entertainment. Music therapy differs from the other practices in that music therapists actively engage clients, can work with mental health, have measurable non-musical goals, document outcomes, and have the longest training period. These other practices are not widely known in the Midwest, but are becoming more well-known on the coasts. As music therapists, then, we not only need to establish ourselves as health professionals [as opposed to "entertainers"], but also be able to educate on the differences between music therapy and these other fields. It is important to respect these other practices, but be able to differentiate and educate the public so they can make informed decisions.

I learned a lot from these sessions and, if you want more information, feel free to ask me. I took copious notes throughout the sessions. I've learned how to more effectively advocate for myself, as a music therapist, and my profession. It was great to see a bunch of other music therapists from around the country. When I work alone so often, it can seem that I'm a "lone ranger", but I'm not! It was good to connect with other MT-BCs and I look forward to more conferences in the future!

By the way, I will begin giving links to other music therapists' blogs at the end of my posts to give my colleagues some love. This week's blog is Soundscape Music Therapy. Rachelle presented the advocacy session I attended yesterday.

Friday, April 6, 2012

Perspective on Goodbye

A few weeks ago, I visited a woman who I have only seen a handful of times. Despite her fairly short time with us so far, we have built a very strong therapeutic relationship. This is dangerous for me, because I know that one way or the other, she will leave our services. She will either get better and be inappropriate for hospice services or she will decline further and die. This is the hardest aspect of hospice care. As a hospice worker, I need to be able to protect myself, keep boundaries between myself and my clients. Every once-in-a-while, however, I don't do a very good job.

This particular client played organ for 30+ years in her church and enjoys a lot of hymns that I've never heard before, so she's been challenging me and stretching me musically. She's still very gracious, though, when I mess up. She still has her cognitive abilities, so she converses easily and I do not feel like I need to "perform" or pretend to be extroverted in our sessions. It's one visit I know I can be myself. I say all this to say that during our last session, she was tearful when we were saying goodbye. She had a pretty quick decline for a few days and she was saying what she thought would be our final goodbye. She shook my hand and said, with tears, "I don't know that I should say 'See you later' this time." I thought for a second and said, "It doesn't matter to me what you say. Either way, whether we see each other or not, I'm glad we've had this time. If we have more time, I'll be very happy, but we can't count on that. We should be grateful for the time we've had and take it one day at a time." That seemed to put it in perspective for her and we said our goodbyes.

Those conversations are always hard to have with people. I guess, on some level, it's a conversation we should all be having all the time. There are so many things that could happen - car accidents, disease, etc - that could make "see you later" not applicable. I know a lot of people take Easter weekends to spend time with family and friends, so I encourage you to take this to heart. Nothing is guaranteed, so make sure every goodbye is suitable for be the last.